SCAN Classic Riverside County, CA Medicare Advantage Plan

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SCAN Classic by SCAN Health Plan, a 2016 Medicare Advantage plan available in Riverside County, CA SCAN Classic is a Medicare Advantage plan, from SCAN Health Plan, that's available in Riverside County, California. This is a Health Maintenance Organization (HMO) option, with a prescription drug plan, for people with Medicare Part A and Part B benefits. It gives you all of the same health insurance benefits as Original Medicare and offers extras that Medicare does not cover.

You can reach SCAN Health Plan directly at (800)915-7226 or (711)- for TTY users.

About Medicare Advantage HMO Plans

The benefit of an HMO plan is lower, predictable out-of-pocket expenses. Although more restrictive than Original Medicare, a HMO plan limits your annual out-of-pocket costs. With Medicare Parts A and B, there's no cap, leaving you vulnerable to excessive medical bills.

IMPORTANT: With an HMO you are required to use healthcare providers in the plan's network. If you don't you will incur additional costs. Also, be aware that your primary care physician must refer you before you can see a specialist.

CRITICAL: The prescription drug coverage included with SCAN Classic has its own deductible and co-pays. If you have prescriptions, make sure your drugs are covered at a favorable price before you join this plan.

Monthly Premium and Deductibles

The premium on this plan is $0.00 per month. That includes your prescription drugs, as well. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventive care mandated by CMS (see H5425-008 Summary of Benefits below).

Although the health plan itself does not have a deductible, the prescription drug plan does. It's $0.00 per year. That means you have first dollar coverage.

IMPORTANT: When evaluating this plan, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.

Maximum Out-of-Pocket (MOOP) Limit for Parts A & B

Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The SCAN Classic plan MOOP is $3,400 . Once you reach this amount of spending on your co-payments, all of your Medicare Part A and Part B services will be covered at no additional charge.

Plans can set their MOOP at a voluntary level of $0 to $3,400 (for in-network services) or a mandatory $3,401 to $6,700 (in-network). Combined totals for in-network and out-of-network are generally higher.

NOTE: MOOP does not include what you spend on monthly premiums. It also does not apply to your prescription drugs or Part D deductible.

CRITICAL: It is important to evaluate the combined annual MA/MAPD premiums and MOOP versus what you might expect to pay for a Medigap plan in Riverside County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage.

Plan Ratings

In this section we show you the quality rating for this plan. Each year the Centers for Medicare and Medicaid Services (CMS) rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this SCAN Health Plan plan.

2016 Overall RatingSCAN Classic Overall Rating
Part C Summary RatingSCAN Classic Medicare Part C Rating
Part D Summary RatingSCAN Classic Medicare Part D Rating
Staying Healthy: Screenings, Tests, VaccinesSCAN Classic Staying Healthy Rating
Managing Chronic (Long Term) ConditionsSCAN Classic Managing Chronic Conditions Rating
Member Experience with Health PlanSCAN Classic Member Experience with Health Plan Rating
Complaints and Changes in Plans PerformanceSCAN Classic Complaints Rating
Health Plan Customer ServiceSCAN Classic Health Plan Customer Service Rating
Drug Plan Customer ServiceSCAN Classic Drug Plan Customer Service Rating
Complaints and Changes in the Drug PlanSCAN Classic Drug Plan Member Complaints Rating
Member Experience with the Drug PlanSCAN Classic Drug Plan Member Experience Rating
Drug Safety and Accuracy of Drug PricingSCAN Classic Drug Safety and Accuracy of Drug Pricing Rating

Part D Prescription Drug Benefits

This plan includes Medicare Part D prescription drug benefits. If you have regular prescriptions, it's critical that you evaluate your costs using the plan's formulary.

Annual Rx Deductible:0.00
Initial Coverage Limit (ICL):$3,310
Gap Coverage:Yes
Plan's Pharmacy Page:http://www.scanhealthplan.com
Plan's Formulary Page:http://www.scanhealthplan.com
Plan Offers an Online Pharmacy:No

Here's what you'll pay at the pharmacy if you join this plan:

TierDrug ClassCopay
1Preferred Generic$5
2Generic$12
3Preferred Brand$47
4Non-Preferred Drug$100
5Specialty Tier33%
6Select Care Drugs$11

IMPORTANT: Once you and your plan provider have spent $3,310 on covered drugs (combined amount plus your deductible), you will be in the donut hole coverage gap. In this phase, unless the plan offers additional coverage, you will pay 45% for brand-name drugs and 58% on generic drugs. This SCAN Health Plan plan does provide additional coverage through the gap.

NOTE: Medicare Advantage plans that include prescription drug coverage (MAPDs) are treated like Medicare Part D plans. Members at higher income levels are subject to the Income Related Monthly Adjustment Amount (IRMAA). In some situations, IRMAA can be appealed. You will need to show SSA evidence of a qualifying event and provide proof of your lower income.

Summary of Benefits (H5425-008)

In this section we outline high-level information about the plan's co-payment and co-insurance costs for inpatient, outpatient, preventive care, transportation and other healthcare services. For complete details, download the SCAN Classic Summary of Benefits.

Outpatient Care and Services

All outpatient health care services (Medicare Part B benefits) have their own co-payment or co-insurance costs. Here's how this plan charges for the basics.

Primary Care Doctor:20% co-insurance
Physician Specialist:$15 co-payment
Chiropractor:$20 co-payment
Occupational Therapist:$10 co-payment
Physical Therapist:$10 co-payment
Speech Terapist:$10 co-payment
Psychotherapist:$30 co-payment
Psychiatrist:$30 co-payment
Podiatrist:$25 co-payment

Lab and Diagnostic Services

Lab and diagnostic services have co-payment or co-insurance costs. Some plans offer these services at no cost, but most do not.

Medicare-covered Diagnostic Procedures/Tests:
Medicare-covered Lab Services:
Medicare-covered Diagnostic Radiological Services:$125 co-payment
Medicare-covered Therapeutic Radiological Services$60 co-payment
Medicare-covered X-Ray Services

Urgent Care and Emergency Services

Urgent care and emergency room services (Medicare Part B benefits) have co-payment or co-insurance costs. Some plans waive these costs if you are admitted as an inpatient within a specified amount of time. Also, plans are not required to offer emergency care worldwide.

Urgent Care:$20 co-payment
Emergency Care:$75 co-payment
Co-insurance waived if admitted within 0 Hours
Worldwide Coverage:Yes
Ambulance:$200 co-payment

Medicare Preventive Care

SCAN Classic covers preventive services, as required by law under Medicare Part B, including:

  • Abdominal aortic aneurysm screening
  • Alcohol misuse counseling
  • Bone mass measurement
  • Breast cancer screening (mammogram)
  • Cardiovascular disease (behavioral therapy)
  • Cardiovascular screenings
  • Cervical and vaginal cancer screening
  • Colorectal cancer screenings
  • Depression screening
  • Diabetes screenings
  • HIV screening
  • Medical nutrition therapy services
  • Obesity screening and counseling
  • Prostate cancer screenings (PSA)
  • Sexually transmitted infections screening and counseling
  • Tobacco use cessation counseling
  • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
  • "Welcome to Medicare" preventive visit
  • Yearly "Wellness" visit

All preventive healthcare services are provided at no cost to the beneficiary. Any additional preventative services approved by Medicare during the contract year will be covered.

Inpatient Care and Services

When you are admitted into a hospital or skilled nursing facility you will make copayments based on benefit periods. A benefit period begins when you are admitted and ends after not receiving inpatient care for 60 days in a row. If you are admitted again after a benefit period has ended a new benefit period begins.

You are required to pay an inpatient deductible for each benefit period. There are no limits on the the number of benefit periods. Here's how this plan charges:

  • There is no inpatient enrollee copay with this plan. You pay nothing.

Hospice

You pay nothing for hospice care from a Medicare-approved (certified) hospice facility. You may have to pay some of the cost for drugs and respite care.

Plan Availability

SCAN Classic is available to beneficiaries living in Mira Loma, Indio, Indian Wells, Palm Desert, Banning, Beaumont, Blythe, Cabazon, Cathedral City, Coachella, Desert Center, Desert Hot Springs, La Quinta, Mecca, North Palm Springs, Palm Springs, Rancho Mirage, Thermal, Thousand Palms, Whitewater, Calimesa, Riverside, March Air Reserve Base, Lake Elsinore, Aguanga, Anza, Hemet, Homeland, Idyllwild, Moreno Valley, Mountain Center, Murrieta, Nuevo, Perris, San Jacinto, Menifee, Sun City, Quail Valley, Temecula, Wildomar, Winchester, Norco, Corona, and all other areas of Riverside County, California.

For assistance 24 hours a day, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048 or visit www.medicare.gov

Tips and Disclaimers

The Medicare Advantage plan data on MedicareWire.com comes directly from Medicare.gov and CMS.gov and is subject to change. The Centers for Medicare and Medicaid Services has neither reviewed nor endorsed the information on this site.

The benefit information provided on this page is a brief summary only, not a complete description. Limitations, co-payments, and restrictions may apply. For more information contact the plan directly at (800)915-7226 or (711)- for TTY users.

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